Using community insight to create ‘social brokerage’ between institutions and unheard voices

by Georgina Hammerton and Sylvana Walcott

Over the last 18 months, the disconnect between institutions and communities has grown ever more apparent. The pandemic has highlighted the increasing inequalities within our society and the inability of mainstream institutions, like the government, the BBC, and the NHS, to provide accessibility and inclusivity.

 Early into the pandemic, Matt Hancock, the former Health Secretary said that people from ethnic minorities were more likely to be affected by the virus and that these communities should be even more vigilant in following the advice being given by the government around following restrictions. Despite this statement – which would have left many communities feeling anxious and worried - they government failed to explain properly in the Public Health England’s review of the relative risk of covid-19 to specific groups – exactly the reason why the risk to ethnic minorities should be higher. Furthermore – despite the Health Secretary stating that he felt a “deep responsibility because this pandemic has exposed huge disparities in the health of our nation” – less than a year later the Race Report published went on to claim that the “UK was not deliberately rigged against ethnic minorities.”

 Considering this context – it is clear to see how the last eighteen months has provided fertile ground for tensions and mistrust to bloom between ethnic minority communities and institutions. At TSIP we have found the work we have been involved with across London, with communities who we are closest too, has reflected many of these concerns and worries around health inequalities. Importantly through our work and research into Covid-19 Experiences Research and Medical Scepticism in South London we have noted that the relationship between minority communities and the healthcare system is fractured – perhaps seemingly beyond repair. Both projects focused in on using qualitative research, including interviews and focus groups, to talk and listen to communities and understand the variety and nuances of their everyday concerns and obstacles. Whilst the Covid-19 experiences research explored themes from education, work, housing issues and mental health, the Medical Scepticism project really honed in on the relationship between ethnic minority communities and healthcare systems. Our insights revealed a complex relationship fraught with suspicion. This is particularly apparent when we consider the vaccine rollout and the hesitancy of many groups to become vaccinated.

 “I’m anti-vaccine, I wouldn’t judge anyone… I just mean personally for me and my kids, I wouldn’t take it.” Covid-19 Experience’s research participant, June 2021

There is clearly a crisis in communications – and through working with our Community Research team to connect institutions and campaigns with the on the ground community views – we have developed a model of ‘social brokerage’ to begin to address this crisis. This model provides a link between two disconnected groups who currently hold asymmetrical power and agency in a nationwide agenda.

Using this model of ‘social brokerage’ alongside, Centric, and our Community Researcher team, TSIP ran a series of facilitated focus groups to assist the development of the new NHS Vaccine Facts campaign being run in South London. ZPB Associates – a healthcare communications agency, working with Southeast London Clinical Commissioning Group (CCG), asked TSIP to run these focus groups to look at the public interaction with their website. These focus groups were designed to test the extent to which people feel like they can find information from the website to address the issues underpinning vaccine hesitancy within their local communities.

In initial conversations ZPB Associates said their challenge was a disconnect between the current vaccine marketing campaign and its engagement with the local community. They had been commissioned to create a new website and communications campaign about the Covid vaccines. Through our previous community research projects, they saw our community engagement methods working efficiently, giving access into the community that institutions were unable to attain.

In the first focus group which looked at the existing Covid web pages on the CCG website, the feedback shared with the CCG were that: the webpage was impenetrable, and it was not accessible for groups that had disabilities. The group also expressed a desire for information to be presented in a variety of formats, including infographics and other interactive formats.

‘I found that there was a lack of community feeling on the website, as it felt as if the people who were in the photographs on there were paid to do it, rather than open-minded people from our community that have experienced it all for themselves. A real picture of community is needed.’ Raquel, Community Researcher

The feedback that we received from the CCG team leading this campaign was that the insights provided by our team were instrumental in the development of the campaign and the driving force behind the creation of the new website. Following this new website launch, we ran a second focus group to test the extent to which issues were being addressed with this revamped website.

 We found through this research that, despite tensions existing between different minority groups and healthcare institutions in these communities, these tensions were still not being addressed. For communities to feel that they are valued and that they are being listened to, these tensions must first be addressed directly by national institutions.

 “It was very insightful to reflect alongside the people in charge of the website. I personally felt that I could give my honest views about it. They asked the relevant questions, and we were able to start a discussion.’ Danna, Community Researcher

To address some of the points raised in the focus group session the content on the Vaccine Facts website has since been updated with information about the new variants, more clarity around the vaccine and pregnancy and fertility and links to independent research papers.

We want to continue to have these conversations about how we address these tensions head-on and pave way to heal these fractured relationships over time. We recognise this is a multifaceted process, and it won’t happen overnight. However, through this model of social brokerage, we hope to bring together different groups of people, who may speak different languages but should strive to create the same outcomes – a more equal future for all.         

“The community focus group was really important in the development of the creative approach for the campaign and website. The group were very clear they didn’t want to be persuaded. We heard that people had questions about the vaccines and misinformation was being seen on social media. The creative approach was suggested by the group - Vaccine Facts. The content on the site is straightforward and deals with the most commonly asked questions about the safety and efficacy of the vaccines. We created accessible videos for all age groups as well as links to reliable research for those who wanted more information. The campaign feature authentic local voices and some of them talked about their concerns about the vaccines - not everyone was comfortable getting the vaccine. The issues around vaccine hesitancy are complex and varied and the campaign could only do so much and ran alongside local community engagement activity. This has proved very successful in terms of how the campaign has been received. Engagement with the content has been very good on social media and NHS London want to use the campaign and website for the whole of London.”

Gita Mendis, Creative director, ZPB Associates